Sleep Apnea Increases Stroke Risk in Elderly

But therapies exist to treat the condition, researchers report

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En Español

By Steven Reinberg
HealthDay Reporter

THURSDAY, Aug. 3, 2006 (HealthDay News) -- Elderly people with severe sleep apnea face more than twice the risk of stroke than people with mild sleep apnea or none, Spanish researchers report.

People with sleep apnea experience episodes when their breathing stops during sleep. Previous studies of the link between stroke and sleep apnea have focused on middle-aged people, but it's older people who have the greatest incidence of stroke, according to study lead researcher Dr. Roberto Munoz, a neurologist at the Hospital de Navarra, in Pamplona, Spain.

In the study, Munoz's team analyzed data from 394 people, 70 to 100 years old, who participated in the Vitoria Sleep Project, in Vitoria, a small town in northern Spain. The researchers interviewed participants to establish basic information such as height, weight, body mass index, neck circumference and medications for high blood pressure, diabetes and cholesterol. The researchers also monitored the patients' overnight breathing patterns.

Over a six-year period, 20 of the study participants had strokes. They were more likely to be male and have severe sleep apnea. In fact, patients with severe sleep apnea had a 2.5-fold increased risk of stroke than patients with no apnea, mild apnea or moderate apnea, Munoz's team found.

"Sleep apnea is two to three times more common in the elderly compared to middle-aged people," Munoz said in a prepared statement. "However, typical symptoms of sleep apnea, such as loud snoring or excessive daytime sleepiness, are less prevalent in the elderly compared to middle-aged people. We should be aware of these symptoms, and specifically look for the presence of repetitive breathing pauses in our patients and relatives."

The findings were expected to be published in the Aug. 4 online edition of Stroke: Journal of the American Heart Association.

Apnea treatment should be started in patients who have a high rate of apnea episodes, particularly in patients with other cardiovascular risk factors, the researchers suggested.

"Snoring is the most important warning sign for sleep apnea," Munoz said. "People who live alone, which is common in the elderly, should be aware that excessive daytime sleepiness is another key risk factor."

One expert agrees that treating sleep apnea is important in reducing the risk of stroke.

"What was known before is that sleep apnea increases the risk for heart attack and stroke," said Dr. Thomas M. Hemmen, an assistant clinical professor of neurology at the University of California, San Diego.

Hemmen noted that treatment for sleep apnea is becoming standard in reducing the risk of both heart attack and stroke. "People with sleep apnea are much more aggressively treated with respiratory aids during the night," he said.

In addition, people with severe sleep apnea tend to be obese, and many have high blood pressure, which are risk factors for stroke, Hemmen said. "High blood pressure is a major risk for stroke, and during the night, blood pressure increases even more. Weight loss programs are important, because obesity correlates with sleep apnea," he said.

Sleep apnea is typically treated with behavioral changes, such as losing weight or sleeping on your side. There are also oral devices that help keep the airway open, according to Stanford University.

More information

The National Institute of Neurological Disorders and Stroke can tell you more about sleep apnea.

SOURCES: Thomas M. Hemmen, M.D., Ph.D., assistant clinical professor of neurology, University of California, San Diego; Aug. 4, 2006, online edition, Stroke: Journal of the American Heart Association

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